God's House Registration Form

* Indicates required field

Childs Name *

First

Last

D.O.B. *

School Class *

Child's Name *

First

Last

D.O.B. *

School Class *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Home Phone Number *

Email *

Mother's Name *

First

Last

Mother's Mobile Number *

Father's Name *

First

Last

Father's Mobile Number *

Best Contact Person for Wednesdays *

First

Last

Phone Number *

Name and number of at least 1 other person authorised to collect child: *

First

Last

Phone Number *

Name *

First

Last

Phone Number *

Name/s of anyone NOT authorised to have access to your child/children: *

Allergies (NB - food only provided before Kids’ Club, during extended hours option): *

Other important information or comments? *

Choose Any *

I permit my child to walk from MVPS to St. John’s church, under supervision, and will inform the school of this arrangement to ensure he/she waits at the designated meeting place for the “walking bus”. (extended hours option only) I give permission for the leaders and volunteers of God’s House @ St. John’s to provide and/or seek appropriate medical attention for my child, should it be necessary. I also permit them to photograph/video my child during activities, on the condition that the images are to be used solely for the purposes of informing the church and local community about the Kids’ Club, as well as creating mementos for families to keep.

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